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Permit No. <br /> APPLICATION FOR SANITATION PERMIT ^ s Ss <br /> (Complete in Duplicate) Date Issued <br /> �Mpplica-�ion is hereby made <br /> to the San4Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. S F9 <br /> �y II --------------•---•---------- <br /> -.S-- -----� <br /> JOB ADDRESS AND LOCATION----------- - ----­­ <br /> Phone.----------------------------------- <br /> lIJY � _ fe-Y-_------------------- ---- <br /> f <br /> Owner's Name.---------- . <br /> Address- ----------------------------------------•------------•-' - ------------------------ <br /> -- ---•-----•-------- - --•--- ----------- Phone----------------------------------- <br /> ------- ------------------------------------------------ <br /> Contractor's Name----------------------------- <br /> ---------- - ------- ------- Other <br /> Apartment House ❑ Commercial ❑ Trailer Court ❑ M"ote <br /> I Installation will serve: Residence� P /00-.Y --- __r.___---------- ---- <br /> s . Number of baths -------- Lot size ._. .--.-..-_ <br /> Number of living units: _.._____ Number of bedrooms --v Private ❑ Depth to Water Table -------- ft. . <br /> Water Supply: Public system Community system ❑ Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Y 7} <br /> Previous Application Made: Yes ❑ <br /> olk <br /> New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: sewer is available within 200 feet.)` Material_- 1 ���_ <br /> [No septic tank or cesspoo permitted if --------- <br /> {i Tank: P Distance from earesr well.._- _0__-.Distance from foundation----)L)-----------P <br /> Li uid de th.-------JWIf�--- Capacity----Q . /�-) <br /> Sep �, q P- <br /> No. of compartments--.._..-__ _ <br /> ----- ----Size------•--�X - <br /> �� /i <br /> Disposal Field: Distance from nearest well.._ -_i---Distance from foundation.._--.- . ._ Distance to nearest lot line........ ........ <br /> P - � � <br /> Number of lines-------------- Length of each line..s.--- -----��-�c' Width of trench------- --- ---- <br /> � /it.. Total length--------- j?` ---------------------- <br /> --- <br /> Type of filter material------- - y V ---Depth of filter material._-.._ <br /> `/ <br /> - Distance to nearest <br /> -- lot line -----. =_-.- <br /> ;: ❑ <br /> D•stance to nearest well------ ---------------Dianefrom foundation <br /> _-__ Dept ------------------------- <br /> Seepage <br /> - - - <br /> See a e Pit: N+umber of pits.---------------------Lining ma : Diameter <br /> Distance from nearest well.................Distance from foundation Lining material------------------------- <br /> Distance <br /> .___..- ----gals. <br /> Cesspool'. .Liquid Capacity_....---•---•---•-----------g <br /> Size: Diameter----- ------------ -------------------Depth------------------------------------------------- <br /> ❑ Distance from nearest building------ ----------------------------------- <br /> Priv Distance from nearest well------ ----- ----- ----------------------------- ---------•--•----•-- ------- -------------- ------ - <br /> y:° ------ ----------------- <br /> - - --------------- <br /> -------------------- <br /> ❑ Distance to nearest of me_..___-_ -----�---- - - - ` <br /> Remodeling and/or repairing (describe):----------------- ------------------------------•---------------•-•---------•------------ ---------- ------------ e <br /> ------.---- ----------•- ---- --------•------- --------------------------------------- - - - -------- ----•----------- <br /> ------ ----- <br /> I -------------•-------------------- --------------------------------------------hat <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws,-and rules and regulations of the San Joaquin Local Health District. <br /> ------------- ------._(Owner and/or Contractor <br /> -- - <br /> (Signed).. -- --------------- - - --------------- ---- <br /> -� (Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot cation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> - DATE.---- ------ ---------------- <br /> APPLICATION ACCEPTED BY....._ - DATE----------------------------------------------------------- <br /> REVIEWED <br /> -----------------------------------REVIEWED BY-------------------------------------------------- -------- <br /> ----------- --- ------------------------------- -------- <br /> =-----'��-"----:------------------------------------------------ <br /> •-------------- ---- --------- DA ------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED:-.- <br /> -------- -- <br /> --------------- ------••--------------- -------------- ------- ----- <br /> Altera+ions and/or recommendations----------..---------------- --.-.--...._..__. <br /> ------- <br /> -------------------- <br /> --------------------------- <br /> ---•-- - bate...------------------- <br /> -------- <br /> F1NAL INSPECTION-BY::. .-- ----------------------•------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street 8!4 North "C" Street <br /> 130 South American Street 300 West Oak Street Tracy. California <br /> Stockton, California <br /> Lodi, California Manteca, California Y' <br /> It - 145446 ATW❑tlD lz-SA _ ru <br /> ES-9-2M <br />